Pelvic floor descent: Dynamic MR imaging using a half-fourier RARE sequence

Abstract

Dynamic magnetic resonance imaging (MRI) using a single shot fast spin‐echo technique was evaluated as a noninvasive alternative to cystourethography or colpocystorectography in patients with pelvic organ prolapse and/or urinary incontinence. Thirty‐two patients were included in this prospective study. Colpocystorectography was performed in 10 patients who previously had undergone hysterectomy and in 2 patients without history of hysterectomy with clinical suspicion of rectoceles. Bead‐chain cystourethrography was performed in 20 patients without hysterectomy. For dynamic MRI, a single‐slice half‐Fourier RARE sequence (imaging time 2 seconds) was used to depict the pelvic organs at different levels of pelvic strain. The results obtained with dynamic MRI were correlated with the x‐ray findings. All 17 cystoceles, 10 rectoceles, 2 enteroceles, and 7 vaginal prolapses could be demonstrated on MRI. Diagnostic information gained from these images was equivalent to that obtained with colpocystorectography and superior to that obtained with cystourethrography; with the latter, important findings were missed (four rectoceles). We conclude that dynamic MRI of the pelvic floor with a half‐Fourier RARE sequence can reliably detect descents of all three pelvic compartments, that it requires no contrast agent, and that no radiation exposure is involved.J. Magn. Reson. Imaging 1999;9:378–383. © 1999 Wiley‐Liss, Inc.

A Novel Concept for the Surgical Anatomy of the Perineal Body

“…[3][4][5][6][7][8] The perineum is particularly exposed to changes in intra-abdominal pressure as they are transmitted through the rectogenital/vesical cul-de-sac. In chronic conditions of increased intra-abdominal pressure, transmission of the pressure through the peritoneal cul-de-sac to the perineum tends to traumatize the PB and perineal muscles.…”

“…[3][4][5][6][7][8] It also is the site of traumatic lesions, the most common of which is episiotomy, which has two types: midline and posterolateral. [9][10][11][12] Contrary to the views of investigators that the PB is the site of insertion of the perineal muscles, we hypothesized that it is the site across which the perineal muscles fibers pass uninterrupted from one side to the other.…”

The current role of imaging techniques in faecal incontinence

“…The reported results of studies comparing MR defecography with conventional defecography in patients with pelvic organ prolapse vary [34][35][36][37]. Some of the variability can be attributed to differences in MR imaging and defecography technique used.…”

Is dynamic two-dimensional anal ultrasonography useful in the assessment of anismus? A comparison with manometry

“…Once identified and quantified, anatomical and functional changes can be correlated with clinical symptoms and proctological findings (6) . Defecography, manometry, electromyography and, more recently, dynamic magnetic resonance scanning and dynamic anorectal ultrasonography, have all been used to diagnose patients with pelvic floor dysfunctions (1,2,3,4,5,6,7,8,9,11,12,13,14,15,16,17,18,19,20,21,22,23,24,26,27,28,29,30) . Advances in ultrasound technology includes the development of the three-dimensional (3D) anorectal transducer and allows to clearly visualize the anatomic configuration of the anal canal in multiplane images (27) but the twodimensional (2D) ultrasound can be useful in the diagnosis of anorectal disease (7,10,24) .…”